Development and Validation of Nomograms for Predicting Pentafecta Outcomes Before and After Robot-assisted Radical Prostatectomy: a Retrospective Study

Overview

Journal Sci Rep

Date 2025 Jan 15

PMID 39814834

Authors

Tanan Bejrananda

Kiyoshi Takahara

Dutsadee Sowanthip

Tomonari Motonaga

Kota Yagi

Wataru Nakamura

Masanobu Saruta

Takuhisa Nukaya

Masashi Takenaka

Kenji Zennami

Manabu Ichino

Hitomi Sasaki

Makoto Sumitomo

Ryoichi Shiroki

Affiliations

Soon will be listed here.

Abstract

Prostate cancer (PCa) is one of the most common cancers among men worldwide, and robot-assisted radical prostatectomy (RARP) is a widely used treatment for localized PCa. Achieving pentafecta outcomes, which include continence, potency, cancer control, free surgical margins, and no major complications, is a critical measure of surgical success and long-term prognosis. However, predicting these outcomes remains challenging. In this retrospective, single-center study, we analyzed data from 1,752 patients who underwent RARP for localized prostate adenocarcinoma between August 2009 and April 2023. The pentafecta outcome was achieved in 290 patients (16.6%). Multivariate analysis revealed that bilateral nerve sparing significantly increased the likelihood of achieving the pentafecta outcome (odds ratio 10.36, 95% CI: 5.75-18.66; p < 0.001). Preoperative potency and bilateral nerve sparing were also identified as key predictors. Nomograms were developed using preoperative and postoperative variables, including age, PSA level, biopsy Gleason score, clinical stage, pathological tumor stage, tumor grade, nerve sparing, and preoperative potency. Internal validation of the nomograms was performed using bootstrapping methods, demonstrating robust predictive performance. These nomograms provide valuable tools for personalized surgical planning and patient counseling and may be applicable to broader populations, given the inclusion of universally recognized predictive factors and rigorous validation. This study presents the development and validation of nomograms to predict pentafecta outcomes before and after RARP. These nomograms provide valuable tools for clinicians to estimate the likelihood of achieving postoperative pentafecta outcomes. Incorporating these nomograms into clinical practice may improve patient counseling and shared decision-making.

References

Sallami S . Predictive factors of urinary incontinence after radical prostatectomy: Systematic review. Tunis Med. 2018; 95(4):229-235. View

Inoue S, Hieda K, Hayashi T, Teishima J, Matsubara A . Longitudinal analysis of trifecta outcome in Japanese patients with prostate cancer following robot-assisted laparoscopic radical prostatectomy. World J Urol. 2020; 40(8):2009-2015. DOI: 10.1007/s00345-020-03515-2. View

Carbin D, Tamhankar A, Ahluwalia P, Gautam G . Robot-assisted radical prostatectomy in indian men of age 75 years and above: a propensity score-matched analysis. J Robot Surg. 2021; 16(4):799-806. DOI: 10.1007/s11701-021-01301-9. View

Brassetti A, Ragusa A, Tedesco F, Prata F, Cacciatore L, Iannuzzi A . Robotic Surgery in Urology: History from PROBOT to HUGO. Sensors (Basel). 2023; 23(16). PMC: 10458477. DOI: 10.3390/s23167104. View

Matsushita K, Kent M, Vickers A, von Bodman C, Bernstein M, Touijer K . Preoperative predictive model of recovery of urinary continence after radical prostatectomy. BJU Int. 2015; 116(4):577-83. PMC: 4768861. DOI: 10.1111/bju.13087. View

van Poppel H, Everaerts W, Tosco L, Joniau S . Open and robotic radical prostatectomy. Asian J Urol. 2019; 6(2):125-128. PMC: 6488736. DOI: 10.1016/j.ajur.2018.12.002. View

Hamdy F, Donovan J, Athene Lane J, Mason M, Metcalfe C, Holding P . 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med. 2016; 375(15):1415-1424. DOI: 10.1056/NEJMoa1606220. View

Ragusa A, Prata F, Iannuzzi A, Tedesco F, Cacciatore L, Rocca A . Safety and feasibility of "three arms settings" robot-assisted radical prostatectomy using the Hugo RAS system: surgical set-up in a double-center large case series. World J Urol. 2024; 42(1):517. DOI: 10.1007/s00345-024-05210-y. View

Singh I, Hemal A . Robotic-assisted radical prostatectomy in 2010. Expert Rev Anticancer Ther. 2010; 10(5):671-82. DOI: 10.1586/era.10.35. View

10.

Patel V, Sivaraman A, Coelho R, Chauhan S, Palmer K, Orvieto M . Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Eur Urol. 2011; 59(5):702-7. DOI: 10.1016/j.eururo.2011.01.032. View

11.

Eastham J, Kattan M, Rogers E, Goad J, Ohori M, Boone T . Risk factors for urinary incontinence after radical prostatectomy. J Urol. 1996; 156(5):1707-13. View

12.

Novara G, Ficarra V, DElia C, Secco S, Cioffi A, Cavalleri S . Evaluating urinary continence and preoperative predictors of urinary continence after robot assisted laparoscopic radical prostatectomy. J Urol. 2010; 184(3):1028-33. DOI: 10.1016/j.juro.2010.04.069. View

13.

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

14.

Bejrananda T, Takahara K, Sowanthip D, Motonaga T, Yagi K, Nakamura W . Comparing pentafecta outcomes between nerve sparing and non nerve sparing robot-assisted radical prostatectomy in a propensity score-matched study. Sci Rep. 2023; 13(1):15835. PMC: 10517009. DOI: 10.1038/s41598-023-43092-z. View

15.

Patel V, Abdul-Muhsin H, Schatloff O, Coelho R, Valero R, Ko Y . Critical review of 'pentafecta' outcomes after robot-assisted laparoscopic prostatectomy in high-volume centres. BJU Int. 2011; 108(6 Pt 2):1007-17. DOI: 10.1111/j.1464-410X.2011.10521.x. View

16.

Guzzo T, Dluzniewski P, Orosco R, Platz E, Partin A, Han M . Prediction of mortality after radical prostatectomy by Charlson comorbidity index. Urology. 2010; 76(3):553-7. PMC: 3643003. DOI: 10.1016/j.urology.2010.02.069. View

17.

DAmico A, Whittington R, Malkowicz S, Schultz D, Blank K, Broderick G . Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998; 280(11):969-74. DOI: 10.1001/jama.280.11.969. View

18.

Tamhankar A, Patil S, Ahluwalia P, Gautam G . Does Continuation of Low-Dose Aspirin During Robot-Assisted Radical Prostatectomy Compromise Surgical Outcomes?. J Endourol. 2018; 32(9):852-858. DOI: 10.1089/end.2018.0390. View

19.

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

20.

Batra V, Gautam G, Jaipuria J, Suryavanshi M, Khera R, Ahlawat R . Predictive factors for lymph node positivity in patients undergoing extended pelvic lymphadenectomy during robot assisted radical prostatectomy. Indian J Urol. 2015; 31(3):217-22. PMC: 4495496. DOI: 10.4103/0970-1591.156918. View